Suchergebnisse

Résumé Les difficultés d'insertion professionnelle sont l'une des caractéristiques majeures du handicap psychique lié à la schizophrénie. Les troubles cognitifs et les symptômes cliniques en sont la cause principale. Cependant, la nature de leurs relations avec l'insertion professionnelle reste mal connue. Cet article présente les résultats d'une étude examinant l'influence des fonctions mnésiques et des symptômes négatifs sur 5 composantes du comportement au travail chez 39 personnes schizophrènes en réinsertion professionnelle. Un deuxième volet de l'étude présente une approche de remédiation cognitive « sur mesure » qui cible des objectifs en lien direct avec les difficultés professionnelles et/ou quotidiennes de la personne. Les programmes ont concerné les fonctions mnésiques et le contrôle attentionnel. Les analyses indiquent que la mémoire à long terme verbale exerce une influence sur les capacités de coopération, la qualité du travail et la présentation personnelle. La capacité d'apprentissage d'informations verbales joue un rôle dans les habitudes de travail. La mémoire de travail qui permet le traitement et le maintien de l'information à court terme ne semble pas exercer une influence sur le comportement au travail. Enfin, les symptômes négatifs déterminent en partie les habiletés sociales et la présentation personnelle. Les résultats des interventions cognitives montrent leur efficacité pour compenser les déficits cognitifs dans l'insertion professionnelle et sociale.

AbstractIntroductionWorldwide, 71 million people are infected with hepatitis C virus (HCV), which, without treatment, can lead to liver failure or hepatocellular carcinoma. HCV co‐infection increases liver‐ and AIDS‐related morbidity and mortality among HIV‐positive people, despite ART. A 12‐week course of HCV direct‐acting antivirals (DAAs) usually cures HCV – regardless of HIV status. However, patents and high prices have created access barriers for people living with HCV, especially people who inject drugs (PWID). Inadequate access to and coverage of harm reduction interventions feed the co‐epidemics of HIV and HCV; as a result, the highest prevalence of HCV is found among PWID, who face additional obstacles to treatment (including stigma, discrimination and other structural barriers). The HIV epidemic occurred during globalization of intellectual property rights, and highlighted the relationship between patents and the high prices that prevent access to medicines. Indian generic manufacturers produced affordable generic HIV treatment, enabling global scale‐up. Unlike HIV, donors have yet to step forward to fund HCV programmes, although DAAs can be mass‐produced at a low and sustainable cost. Unfortunately, although voluntary licensing agreements between originators and generic manufacturers enable low‐income (and some lower‐middle income countries) to buy generic versions of HIV and HCV medicines, most middle‐income countries with large burdens of HCV infection and HIV/HCV co‐infection are excluded from these agreements. Our commentary presents tactics from the HIV experience that treatment advocates can use to expand access to DAAs.DiscussionA number of practical actions can help increase access to DAAs, including new research and development (R&D) paradigms; compassionate use, named‐patient and early access programmes; use of TRIPS flexibilities such as compulsory licences and patent oppositions; and parallel importation via buyers' clubs. Together, these approaches can increase access to antiviral therapy for people living with HIV and viral hepatitis in low‐, middle‐ and high‐income settings.ConclusionsThe HIV example provides helpful parallels for addressing challenges to expanding access to HCV DAAs. HCV treatment access – and harm reduction – should be massively scaled‐up to meet the needs of PWID, and efforts should be made to tackle stigma and discrimination, and stop criminalization of drug use and possession.

Global commitments aim to provide antiretroviral therapy (ART) to 15 million people living with HIV by 2015, and recent studies have demonstrated the potential for widespread ART to prevent HIV transmission. Increasingly, countries are adapting their national guidelines to start ART earlier, for both clinical and preventive benefits. To maximize the benefits of ART in resource‐limited settings, six key principles need to guide ART choice: simplicity, tolerability and safety, durability, universal applicability, affordability and heat stability. Currently available drugs, combined with those in late‐stage clinical development, hold great promise to simplify treatment in the short term. Over the longer term, newer technologies, such as long‐acting formulations and nanotechnology, could radically alter the treatment paradigm. This commentary reviews recommendations made in an expert consultation on treatment scale up in resource‐limited settings.